Greg Giles Insurance

Medicare Advantage Plans

(A general summary of how they work - please refer to CMS approved marketing materials for specifics of Medicare Plans offered by specific companies - I can provide you with these materials)

Overview

Originally designed to reduce Medicare Costs and provide additional benefits not covered by Medicare.
Lower Premium than Medicare Supplements and not tied to age (some Medicare Advantage plans actually cost more than Medicare Supplement Plans)
HMO plans have a "Gate Keeper" that you must go through in order to receive services at lower co-pays. HMO plans require the use of network providers. PPO and POS plans allow the use of non-network providers; just keep in mind that out of network services will cost you more money. PPO plans are a much better choice than HMO plans because you can see out of network providers more easily.
Same coverage as Original Medicare with additional benefits
Cost sharing - you have co-pays - this is why the premiums are lower!
Beware of the excess charges and out of pocket maximum in Medicare Advantage plans. Some have different out of pocket maximums for in and out of network services. Some do not protect you from excess charges that providers can charge (15% of the Medicare amount).
You will have NO choices when it comes to prescription drug plans - you have to take the drug benefits offered by the plan. Remember if you cannot choose drug coverage among several companies you will most likely not be getting the best buy. Rx plan costs can vary significantly.
Providers can choose not to participate with these plans from time to time. (you may have to switch doctors occasionally)
These plans change their benefits each year as they re-file the plan with Medicare. Beware! - the plan you purchase today will look different in five years.
Medicare Advantage plans tend to give away the cheap stuff like office calls, routine lab tests, preventative exams and the like - but look closely at the co-pays for the expensive stuff, hospital stays, Part B Medications (cancer treatments are here) and Expensive diagnostic tests - your pay dearly for those in the lower cost Medicare Advantage plans.

The premium for an HMO/PPO plan is certainly attractive - I recommend that you select a PPO plan over an HMO or PFFS plan, if you do choose Medicare Advantage.

You must have both parts A and B of Medicare

You need to look at your current health condition and your family history - and choose the plan that offers the benefits you want.

Compare potential costs in addition to the part B Medicare Premium.

Plan F - Monthly Premium & coverage begins with the 1st dollar.
HMO / PPO - a lower monthly Premium & you have co-pays for services.
Plan F allows you to choose from many drug plans / HMO/PPO plans have a singel choice
Either way the medical provider submits only one claim and you do no paperwork.

The Outlines of Coverage and Summary of Benefits booklets for each specific plan will tell you much more.

Before you choose an Medicare Advantage Health Plan - Please let me show you how to sort them all out. This will save you a great deal of time and frustration. There are numerous indemnity plans to cover the high hospital and equipment costs buried in these types of plans. I really think you will end up happier with a Plan N Medicare Supplement if you like the way Medicare Advantage plans work.

Most Choose plan F when they can afford the premium.

My objective is to help you be an informed consumer, answer the questions that you have and offer the coverage you desire at the lowest possible premium.

NOTE: The billings from Medicare Advantage Plans get confusing at times - Do you want this?

Do You Ride The Bus?

Do You Drive A Car?

Think of a Medicare Advantage plan as like riding the bus.

It may cost a little less than owing a car, but you have to put money in the bucket every time you use it.

You have to get on and off where the bus says to get on and off and if you go off the scheduled route it is going to cost extra.

This of a Plan F Medicare Supplement plan as like driving a car.

You get to go where you want when you want. It may cost a little bit more to operate a car, but the luxury of the freedom that you get with that is definitely worth it.

Remember what your mom told you as you were growing up?

"You get what you pay for!"

If you are hardly paying a premium for one of theose Medicare Advantage plans, then there may not be as much advantage in it as you probably think. For a good example - Look into the cost of cancer treatments and part B Medications!